Transversus thoracis muscle plane plus rectus sheath block improve perioperative analgesia for cardiac surgery: a randomized double-blind controlled trial

The transverse thoracic muscle plane block (TTPB) covers the thoracic intercostal nerves T2–T6, while the rectus sheath block (RSB) relieves the cutting pain from drainage tubes placed under the xiphoid. Bilateral TTPB combined with RSB may represent a new analgesic strategy for thoracotomy, though its clinical efficacy remains uncertain. In a single-center, randomized, double-blind, controlled clinical trial, patients scheduled for coronary artery bypass grafting or heart valve surgery via median sternotomy were randomized to receive either 0.3% ropivacaine (n = 30) or 0.9% normal saline (n = 29) for TTPB (15 ml) and RSB (10 ml) on each side. The primary outcome was total sufentanil consumption during surgery. Other outcomes included the postoperative visual analogue scale (VAS) score, time to extubation, length of intensive care unit stay, and days of hospitalization. Significant improvements were observed in the TTPB + RSB group compared to the control group. Intraoperative sufentanil consumption was significantly lower (25 [19.2–33.1] µg vs 55 [49.6–79.3] µg, p < 0.001). The TTPB + RSB group required fewer analgesic pump activations and less total pump volume. Patients in the TTPB + RSB group had a shorter time to extubation and a reduced length of ICU stay. VAS pain scores were also significantly lower at both 24 h and 48 h postoperatively. The groups did not differ significantly with respect to length of hospital stay or the incidence of adverse events. Bilateral TTPB + RSB blockade significantly reduces intraoperative sufentanil consumption, enhances postoperative pain relief, and accelerates recovery. Trial registration number NCT04838132.